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US 2014/0005742 A1Published application
System and method for selection of pacing vectors
AssigneeCardiac Pacemakers, Inc.
InventorsDeepa Mahajan, Yanting Dong, Sunipa Saha, Holly Rockweiler, Kenneth N. Hayes, Krzysztof Z. Siejko, Clayton S. Foster
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Abstract
Various techniques are disclosed for quickly and efficiently determining cardiac pacing vectors that minimize phrenic nerve stimulation.
Claims20
A system comprising:
- an implantable medical device configured to deliver pacing stimuli to a heart;
- and
- at least one processor configured to:
- for a set of at least two pacing vectors, wherein each vector is at least partially defined by a first electrode and a second electrode:
- deliver at least one first pacing stimulus at a first specified pacing energy;
- determine whether, in response to the delivered at least one first pacing stimulus, a first cardiac depolarization occurred and whether a first phrenic nerve stimulation occurred, the determination using physiological information received in response to the delivered at least one first pacing stimulus;
- adjust the pacing stimulus to determine a first pacing threshold value;
- and
- categorize acceptability of the first electrodes of the at least two pacing vectors using information about at least one of the determined first pacing threshold value, whether the first cardiac depolarization occurred, or whether the first phrenic nerve stimulation occurred;
- pair one or more respective categorized acceptable first electrodes with one or more respective candidate second electrodes capable of use therewith, and for a particular pairing:
- deliver at least one second pacing stimulus at at least one second pacing energy;
- determine whether, in response to the delivered at least one second pacing stimulus, a second cardiac depolarization occurred and whether a second phrenic nerve stimulation occurred, the determination using physiological information received in response to the delivered at least one second pacing stimulus;
- and
- categorize the pairings using information about at least one of whether the second cardiac depolarization occurred or whether the second phrenic nerve stimulation occurred;
- evaluate the categorized pairings using information about a margin between the second pacing stimulus and the second phrenic nerve stimulation threshold;
- and
- select at least one pairing, based on the evaluation, for use in subsequent ongoing delivery of pacing stimuli.
14 more elements
A computer-readable medium comprising instructions that, upon execution, cause at least one processor to:
- for a set of at least two pacing vectors, wherein each vector is at least partially defined by a first electrode and a second electrode:
- deliver at least one first pacing stimulus at a first specified pacing energy;
- determine whether, in response to the delivered at least one first pacing stimulus, a first cardiac depolarization occurred and whether a first phrenic nerve stimulation occurred, the determination using physiological information received in response to the delivered at least one first pacing stimulus;
- adjust the pacing stimulus to determine a first pacing threshold value;
- and
- categorize acceptability of the first electrodes of the at least two pacing vectors using information about at least one of the determined first pacing threshold value, whether the first cardiac depolarization occurred, or whether the first phrenic nerve stimulation occurred;
- pair one or more respective categorized acceptable first electrodes with one or more respective candidate second electrodes capable of use therewith, and for a particular pairing:
- deliver at least one second pacing stimulus at at least one second pacing energy;
- determine whether, in response to the delivered at least one second pacing stimulus, a second cardiac depolarization occurred and whether a second phrenic nerve stimulation occurred, the determination using physiological information received in response to the delivered at least one second pacing stimulus;
- and
- categorize the pairings using information about at least one of whether the second cardiac depolarization occurred or whether the second phrenic nerve stimulation occurred;
- evaluate the categorized pairings using information about a margin between the second pacing stimulus and the second phrenic nerve stimulation threshold;
- and
- select at least one pairing, based on the evaluation, for use in subsequent ongoing delivery of pacing stimuli.
11 more elements
A method of determining at least one cardiac pacing vector, the method comprising:
- for a set of at least two pacing vectors, wherein each vector is at least partially defined by a first electrode and a second electrode:
- delivering at least one first pacing stimulus at a first specified pacing energy;
- determining whether, in response to the delivering the at least one first pacing stimulus, a first cardiac depolarization occurred and whether a first phrenic nerve stimulation occurred, the determining using physiological information received in response to the delivering the at least one first pacing stimulus;
- and
- adjusting the pacing stimulus to determine a first pacing threshold value;
- categorizing acceptability of the first electrodes of the at least two pacing vectors using information about at least one of the determined first pacing threshold value, whether the first cardiac depolarization occurred, or whether the first phrenic nerve stimulation occurred;
- pairing one or more respective categorized acceptable first electrodes with one or more respective candidate second electrode capable of use therewith, and for a particular pairing:
- delivering at least one second pacing stimulus at at least one second pacing energy;
- determining whether, in response to the delivering the at least one second pacing stimulus, a second cardiac depolarization occurred and whether a second phrenic nerve stimulation occurred, the determining using physiological information received in response to the delivering the at least one second pacing stimulus;
- and
- categorizing the pairings using information about at least one of whether the second cardiac depolarization occurred or whether the second phrenic nerve stimulation occurred;
- evaluating the categorized pairings using information about a margin between the second pacing stimulus and the second phrenic nerve stimulation threshold;
- and
- selecting at least one pairing, based on the evaluation, for use in subsequent ongoing delivery of pacing stimuli.
11 more elements
Dependencies are inferred from the claim text.